Preface

Antimicrobial resistance (AMR) has emerged as the most serious global health concern. AMR hampers effective prevention and treatment of infections due to the ever-increasing range of bacteria that are becoming more powerful because of the development of novel re‐ sistance mechanisms against existing and newer antibiotics. Although AMR occurs natural‐ ly in bacteria, indiscriminate use of antibiotics in the human health sector and in livestock production is accelerating its development and spread to otherwise nonresistant bacteria through different modes. Different agencies such as the World Health Organization recog‐ nized AMR as a global threat and emphasized the need for an improved and coordinated global effort to control it.

An increasing number of infections, which were earlier easy to control, are now difficult to treat due to the development of resistance, further leading to increased medical costs, longer stays in hospital, and increased morbidity. Considering the prevailing scenario of antimicro‐ bial resistance, urgent and sincere efforts are required right from the level of individuals to the level of policymakers to curb the resistance crisis. Moreover, there is a need to change antibiotic usage behavior, wherein the way to prescribe and use antibiotics should be looked into because unregulated usage of antibiotics is the most significant factor in the develop‐ ment of AMR.

To deal with this crisis, various aspects of AMR should be taken into consideration, includ‐ ing the study of prevailing antibiogram patterns among different bacteria from humans, ani‐ mals, and the environment; development of newer classes of antibiotics to combat resistance mechanisms; detection of novel targets for antibiotics; reconsideration of conventionally used drugs showing re-emergence of susceptibility; and development as well as evaluation of alternative therapies.

This book contains seven chapters discussing different aspects of AMR. The first chapter is an introduction to the magnitude of the problem of antibiotic resistance, its causes, and miti‐ gation strategies. The second chapter highlights the importance of antibiotic resistance in zoonotic bacteria. The problem of indiscriminate use of antibiotics in animal production and its role in the development of resistance is discussed in the third chapter. The fourth chapter discusses the problem of antibiotic resistance in lactic acid bacteria, whereas Chapter 5 high‐ lights the development of resistance in wastewater treatment plants making them a signifi‐ cant source of environmental resistance. The sixth and seventh chapters describe alternative therapies: medicinal plants and beneficial microbes, respectively.

I put this book together with strong belief that it will provide information to all researchers working on the problem of AMR. The book will also help in understanding the seriousness of the problem and the necessity of framing strategies and policies to control the develop‐ ment and spread of antimicrobial resistance, in addition to the need for newer antibiotics and alternative therapies.

My heartfelt gratitude goes to Dr. A. K. Tahlan, Director, CRI, Kasauli, for his unwavering support throughout the book project. I would also like to thank my colleagues and subordi‐ nates for their unending motivation. Finally, my gratitude and love go to my family for their continuous inspiration and support.

**Dr. Yashwant Kumar**

**Chapter 1**

**Provisional chapter**

**Introductory Chapter: Stepping into the Post-Antibiotic**

**Introductory Chapter: Stepping into the Post-**

**1. Antibiotics and antibiotic resistance in the pre-antibiotic era**

Antibiotics are known to exist in the history of mankind since ancient times. They can be traced back to as early as 350–550 CE, when scientists found traces of tetracycline inhuman skeletal remains of ancient Sudanese Nuba [1]. This has led to the speculation that the diet of this population contained tetracycline. Even the red soils of Jordon which have been used since time immemorial to treat wounds have been shown to contain *Actinomycete* bacteria which produced actinomycin [2]. Antimicrobial activity is also present in many of the herbs

Antibiotics have saved countless lives, and at one point of time, we imagined that infectious diseases were conquered. Most of the advances of modern medicine including state of art surgeries and management of neutropenic, transplant and cancer patients are based on the use of effective broad-spectrum antibiotics. Thanks to the way we have handled these precious resources for treatment of variety of infectious diseases. However, we found to our dismay

Antibiotic resistance genes have been present in nature long before the modern antibiotic era began. Some of the serine and metallo-beta-lactamases originated more than 2 million years ago [3]. It seems prudent to assume that the ancient bacteria had defence mechanisms (such as antibiotic altering enzymes or efflux pumps) to protect themselves from high antibiotic concentrations. Hence, the biosynthetic gene cluster that makes the "antibiotic" must also contain genes which confer "resistance" to these antibiotics, and many aspects of the resistome (collection of all AMR genes in a specific bacteria or ecological niche) might have developed much

**Antibiotic Era—Challenges and Solutions**

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.84486

**Era—Challenges and Solutions**

Ajay Kumar Tahlan and Yashwant Kumar

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Neelam Taneja, Shveta Sethi, Ajay Kumar Tahlan

used in traditional Indian Ayurvedic and Chinese medicines.

subsequently that we are stepping into the post-antibiotic era.

before these antibiotics became prevalent in clinical practice.

Neelam Taneja, Shveta Sethi,

and Yashwant Kumar

http://dx.doi.org/10.5772/intechopen.84486

National Salmonella and Escherichia Centre/Diagnostic Reagents Laboratory Central Research Institute Kasauli (HP), India

#### **Introductory Chapter: Stepping into the Post-Antibiotic Era—Challenges and Solutions Introductory Chapter: Stepping into the Post-Antibiotic Era—Challenges and Solutions**

DOI: 10.5772/intechopen.84486

Neelam Taneja, Shveta Sethi, Ajay Kumar Tahlan and Yashwant Kumar Neelam Taneja, Shveta Sethi, Ajay Kumar Tahlan and Yashwant Kumar

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.84486

ment and spread of antimicrobial resistance, in addition to the need for newer antibiotics

My heartfelt gratitude goes to Dr. A. K. Tahlan, Director, CRI, Kasauli, for his unwavering support throughout the book project. I would also like to thank my colleagues and subordi‐ nates for their unending motivation. Finally, my gratitude and love go to my family for their

National Salmonella and Escherichia Centre/Diagnostic Reagents Laboratory

**Dr. Yashwant Kumar**

Central Research Institute Kasauli (HP), India

and alternative therapies.

VIII Preface

continuous inspiration and support.
